Traveller's Diarrhoea

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Traveller’s diarrhoea affects many travellers going to destinations in Africa, Asia and South America. The antibiotic azithromycin is a fast and effective treatment for traveller’s diarrhoea. Travellers going to a risk area should take a course of azithromycin with them, in case they contract the infection.

To buy azithromycin for traveller’s diarrhoea you need to fill in a brief questionnaire. Our doctor will review your answers and make sure the antibiotic is safe for you to take.

What is traveller's diarrhoea?

Diarrhoea is when you are passing stools more frequently than is normal for you or passing looser stools than usual. You can get diarrhoea as a result of stress or drinking too much caffeine or alcohol, but often it is caused by an infection in the bowel known as gastroenteritis. Gastroenteritis can be caused by a virus, bacteria or a parasite. It is very common for people travelling to other parts of the world, i.e. Asia, the Middle East, Africa and Latin America, to get bacterial or viral diarrhoea, also known as travellers’ diarrhoea. Normally, traveller's diarrhoea will go away by itself within about 3 days. In some cases, you might find it lasts for a week (particularly in children, who often take longer to bounce back). If the diarrhoea is frequent or severe, it can lead to dehydration, so you need to make sure you drink plenty of water.

How to treat traveller's diarrhoea?

Normally traveller's diarrhoea will pass by itself within about 3-7 days. About 10% of cases last over a week and about 2% for more than a month, according to the British Medical Journal. If you have diarrhoea, you can dehydrate quite quickly, especially if you are also vomiting – drink plenty of fluids to rehydrate. Taking small sips of water frequently can help. You can also take an oral rehydration solution – this is a sachet of powder that you dissolve in water and drink to replace salt, glucose and other minerals that are lost when you body is dehydration. You can ask your pharmacist about this.

You need to be especially careful to avoid dehydration in children.Medical opinion is divided over whether you should eat if you’ve got diarrhoea. Most specialists say that if you can eat and feel like eating, you should try to have a small light meal of solid foods. Avoid eating anything spicy or heavy. If you don’t feel like eating, you don't need to force yourself. Just drink plenty of fluids and start to eat when you feel up to it.

Which treatment for traveller's diarrhoea is there?

Azithromycin is a macrolide antibiotic used to treat bacterial infections. It works by containing the infection, which means the infection cannot spread and your body’s immune system can fight it off. Lopermide works by slowing down muscle movements in the gut. This means that a greater amount of water is absorbed from the stools, so the stools are less loose and passed less frequently.

Statistics

20-60% of people who travel to high risk parts of the world, i.e. Asia, the Middle East, Africa and Latin America, get travellers’ diarrhoea. Annually about 100 million people travel from developed countries to these areas, resulting in up to 40 million cases of traveller's diarrhoea each year, according to a recent research paper by the National Centre for Biology Information.

What are the symptoms of traveller's diarrhoea?

Symptoms may vary depending on the severity of the diarrhoea. If you have mild diarrhoea, you might have a slight upset stomach for a short while, with stools that are a bit watery. If you have more severe diarrhoea, you might have very watery stools over a prolonged period of time. If you’ve got diarrhoea caused by a bacterial infection, you might have a fever, headache, stomach cramps, loss of appetite, nausea and/or be vomiting, as well as having diarrhoea.

What are the causes and how can I prevent getting it?

Usually, severe traveller's diarrhoea is caused by bacterial and viral infections. The season can affect the risk – you are more likely to pick up diarrhoea caused by bacteria in the rainy season (or diarrhoea caused by a virus in the dry season). The type of travel also influences this – camping and backpacking put you at a higher risk than business travel.

You also can pick up a viral infection by direct contact, so you need to wash your hands regularly to prevent it (especially after going to the bathroom, before you eat, after coming into contact with animals, or after contact with another person who has diarrhoea.) If you can’t wash your hands with soap and water, use a hand sanitiser.

You can also catch bacterial diarrhoea by eating contaminated food or drinking contaminated water. Bacterial diarrhoea is often severe and comes with cramps, headache, fever and loss of appetite, as well as nausea and vomiting. There are several things you can do to prevent getting it:

Drink bottled or sterilised water (use this for everything you might eat or drink, e.g. to wash fruit, clean your teeth or make ice). Don’t eat salads (the ingredients may have been washed in contaminated water).

Be careful when eating dairy products. They may be unpasteurised.Only eat food that is piping hot and hasn’t been left out at room temperature. Hot food should have been kept hot and cold food should have been kept cold.

Who gets it?

Anyone can get travellers’ diarrhoea. High-risk parts of the world include Asia (particularly Southern Asia), the Middle East, Africa and Latin America. 20-60% of travellers visiting these areas get travellers’ diarrhoea.

How is traveller's diarrhoea diagnosed?

You should see a doctor if:

Your baby has six or more episodes of diarrhoea in 24 hours

Your child has six or more episodes of diarrhoea, has blood in their stools, has diarrhoea and vomiting at the same time, has very watery stools, has diarrhoea that lasts two weeks.

As an adult, you should see a doctor if you have diarrhoea and were in hospital recently, if you’ve been treated with antibiotics lately, if your diarrhoea has blood in it, if you are vomiting a lot as well as having diarrhoea, if you are losing weight, if your rectum is bleeding, if you have diarrhoea at night that is disturbing your sleep, if you’ve passed a great quantity of very watery diarrhoea, or if you’ve had diarrhoea for more than 7 days.

Long term issues

About 10% of cases of travellers’ diarrhoea last over a week and about 2% for more than a month, according to a paper published by the British Medical Journal. If you have had continuous symptoms for longer than 10 days, see a doctor so that your stools can be checked for parasites, such as Giardia and Cryptosporidium. Between 5 and 10% of people who have had travellers’ diarrhoea later fulfil the criteria for irritable bowel syndrome. This is referred to as post-infection irritable bowel syndrome.

After treatment, what should I expect?

It can take up to 48 hours for Loperamide to improve your symptoms. Keep taking the medication as directed and speak to a doctor if it does not help within two days. Like all antibiotics, you need to complete the course for Azithromycin to work. Azihromycin will start working on the first day, but you may need to wait three days until you notice an improvement.

Do I need a prescription?

You can get Loperamide and oral rehydration solution from the pharmacy. You need a prescription to get Azithromycin.

Can I get treatment on the NHS?

Yes. Speak to your GP about getting Azithromycin as a standby to take abroad with you.

Which traveller's diarrhoea treatment options are there?

You can reduce the frequency of the diarrhoea by taking an antidiarrhoeal medicine such as Loperamide. This will make the stools firmer, so you’ll need to pass them less frequently. It can take up to 48 hours for Loperamide to improve your symptoms. Keep taking the medication as directed and speak to a doctor if it does not help within two days. Severe cases of diarrhoea may need to be treated with an antibiotic, such as Azithromycin. If you are going abroad, you might like to ask your doctor for Azithromycin to take with you just in case you fall ill and need it. Like all antibiotics, you need to complete the course for Azithromycin to work. Azihromycin will start working on the first day, but you may need to wait three days until you notice an improvement.

If you have got a fever or a headache you could consider taking painkillers, such as paracetamol or ibuprofen. Azithromycin appears to be effective in most cases of Travellers’ Diarrhoea, according to a recent article published by the Centre for Disease Control and Prevention. Studies suggest, that Loperamide is as effective as other anti-diarrhoeal medications.

If you would like to take a traveller's diarrhoea treatment with you on your next trip, you can order online from DrEd. We offer free prescription and delivery and will provide you with azithromycin tablets to take if you fall ill with diarrhoea while abroad.

Loperamide Side Effects and Risks

Loperamide is not suitable for everyone. Don’t take Loperamide if you are pregnant or breastfeeding. You should consult your doctor before taking Loperamide if you:

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